Anne Burns works for NHS Greater Glasgow and Clyde based in Renfrewshire and has been one of the people at the forefront of implementing the Family Nurse Partnership model (FNP).
Her job involves what she describes as ‘a structured intensive home visiting programme’ for young mums, aged 19 and under having their first baby. Young women are invited to voluntarily enroll on the two and a half-year programme early in their pregnancy, and are visited by a specially trained Family Nurse.
The concept was started in the USA 40 years ago, has a strong evidence base, and it is being rolled out in Scotland as a key part of the Government’s national Getting it Right for Every Child (GIRFEC) approach.
Having done nursing, midwifery and health visiting early in her career, Anne grew interested in population health and became a Public Health Practitioner and then Health Improvement Lead for Maternal and Child Health with NHSGGC. Reading about Family Nurse Partnerships inspired her to want to return to frontline nursing. “All the jobs I’ve ever had have led me to this,” she says.
“It’s a demanding job and requires a range of skills,” she says. “Some of the clients have experienced many adverse childhood events, and relationships will inevitably rupture and repair at times. But we commit to the task wholeheartedly, and do everything we can to model respectful relationships. Building a trusting therapeutic relationship is at the centre of the programme.”
The Family Nurse Partnership approach has been thought through in detail: the nurses are notified of potential clients mainly via maternity services, and introductions are made – by text message – as early in pregnancy as possible.
Weekly home visits take place during pregnancy and early infancy, then fortnightly until the baby reaches their second birthday, by which time the family’s care passes to Health Visitors.
Working one-to-one, the Family Nurse and client tackle together whatever arises. “If a young mum is stressed by constant crying, I’ll ask ‘what’s the baby trying to say to you?’” says Anne. “We’ll work out what the baby wants that way, and defuse the situation before it gets worse. It’s about demonstrating the simple tools they can use in everyday life.”
As well as carrying her own small caseload, Anne supervises six family nurses. The team has 150 clients coming from diverse social backgrounds. “We do what we can to help them find a secure base, and work on their life challenges together,” says Anne. “We advocate for them with other agencies, but we also provide the scaffolding for the young people to take control themselves.
Each of the six highly-experienced Family Nurses has a caseload of 25 clients each. It is a resource-intensive way of working but it will generate significant savings down the line. “If we prevent referrals for child protection, keep kids out of care, and ensure that more children start life healthy and happy, then it is well worth it economically and personally,” says Anne.
To complement the quantitative evidence, Anne is building a qualitative evidence base by capturing the experiences of the first cohort of clients. “They complete the programme as more resilient adults,” says Anne, who has clients who are now attending college and university and in work. “It may be the hardest job I’ve ever done, but it is also the most satisfying as you get to see the difference you make.”
It was Anne’s commitment to innovation that won her a place on the Queen’s Nursing programme. “It is an endorsement of everything I believe in as a nurse,” she says. “What I’m learning is being taken back to benefit my colleagues and the young families we work with.”
Anne, whose mantra is ‘Be bold, creative and strong’, says: “This is a strengths-based approach, but we are not blind to deficits. The baby’s wellbeing is at the centre of the work we do, and sometimes we need to request assistance from partner agencies.
“This is a challenging role and takes a lot of energy, however it is immensely rewarding when we see the young women and their babies flourish on the programme – it’s a privilege that we get to go on an important life changing journey with them.”